Insurance company off hook for woman’s $ 27,000 medical bill
Appeal court throws out earlier ruling that policy was hard to decipher
AThe appeal panel disagreed, saying ‘ the exclusion was unambiguous’ and his ruling flew in the face of the long- established principles governing the interpretation of insurance policies.
Victoria woman must pay $ 27,000 in U. S. medical bills because she didn’t bother to read her travel insurance policy, the B. C. Court of Appeal says.
It unanimously rejected a lower- court ruling that the policy was difficult to understand.
The justices said the exclusion was completely reasonable, predictable and unambiguous.
“With respect, it cannot be that simply requesting travel insurance, receiving a policy, and then not reading it can operate to create a reasonable expectation of coverage that will overcome the clear words of the policy,” said Justice Kathryn Neilson. “Indeed, it is difficult to understand how an insured could have a reasonable expectation of what loss may be covered if she has not read the policy.”
Justices David Frankel and Anne MacKenzie concurred.
On Aug. 26, B. C. Supreme Court Justice R. D. Wilson said Sandra Turpin had an expectation of coverage and Manufacturers Life should pay $ 27,170.81 plus interest for breach of contract.
In September 2007, Turpin experienced abdominal pain that got so bad she visited a walk- in clinic. Later she went to the emergency department of a Victoria hospital, where a variety of tests were performed but she was discharged.
On Sept. 25, 2007, she consulted her family doctor and began taking antibiotics. The pain dissipated and on Sept. 28 she and her husband, John, planned a trip to California.
The next day, she purchased a travel insurance policy from an agent who emphasized there were limitations or restrictions in the policy. “The front page of the policy also advised there may be limitations and exclusions to coverage, and stated: ‘ PLEASE READ YOUR POLICY CAREFULLY BEFORE YOU TRAVEL,’ ” Justice Neilson pointed out. “Ms. Turpin did not read the policy.”
The couple flew to California and on Oct. 6, 2007, Turpin fell ill. A doctor at a walk- in clinic prescribed medication and told her to consult a physician if she saw no short- term improvement. She was admitted to a hospital the next day in Newport Beach, where she received treatment until Oct. 12, when she was able to return to Victoria.
She ultimately had an appendectomy in Victoria on Dec. 10, 2007, and claimed for the medical costs incurred in California.
In January 2008, the insurer rejected her claim because Turpin suffered from an “unstable pre- existing condition.”
The couple sued, but the appeal court said the clause was clear: “Exclusion 1: preexisting conditions or related medical conditions which were not stable and controlled during the 90- day period immediately preceding your effective date.”
Although Turpin was not eligible for coverage on the wording of the policy, trial Justice Wilson said it was appropriate to apply the “reasonable expectations principle” to permit her to recover her expenses.
He concluded “that if she had read the policy, she would have found it difficult to understand, with its myriad of excluding conditions, variously applicable, or not applicable, to an infinite array of possible risks.”
The appeal panel disagreed, saying “the exclusion was unambiguous” and his ruling flew in the face of the longestablished principles governing the interpretation of insurance policies.
“The Supreme Court of Canada has repeatedly and consistently affirmed that the reasonable expectations of the parties only become relevant if the provisions of an insurance contract are ambiguous,” Justice Neilson said.
“There is no evidence to indicate the insurer misled the Turpins in providing the travel insurance. This was an off- the- shelf policy. While the agent did not explain it, she did advise Ms. Turpin it had limitations and restrictions.
“As well, the cover of the policy included a warning that ‘ coverage may be subject to exclusions or limitations,’ and a statement urging the insured to read it carefully. Ms. Turpin did not read it … This is a reasonable and predictable exclusion.”